Comparison of Accuracy of Pedicle Screw Insertion Among 4 Guided Technologies in Spine Surgery

Abstract

BackgroundAs an available new tool for spinal surgery, robotic technology holds great potential and has been demonstrated to have better clinical outcomes compared with traditional techniques. However, it has not been compared with other assisted tools for the treatment of lumbar degenerative disease. This article focused on studying such variances.Material/MethodsA total of 176 pedicle screws were inserted in 39 patients using a spine robot (group 1), 134 screws were implanted in 28 patients using navigational template (group 2), 234 screws were implanted in 51 patients by O-arm-based navigation (group 3), and 346 screws were implanted in 72 patients by fluoroscopy-guided assistance (group 4). The screw position was evaluated using postoperative scans according to Rampersaud A to D classification, and other secondary data were also collected.Results“Perfect” pedicle screw insertion (Grade A) was 90.34%, 91.79%, 84.19%, and 65.03% of groups 1–4, respectively. “Clinically acceptable” screw implantation (Grade A+B) was 94.32%, 95.52, 90.60%, and 78.03% in groups 1–4, respectively. Deviation sagittal (°) respectively was 3±9, 2±10, 4±7, and 10±8° in groups 1–4, respectively. Deviation transversal (°) screw insertion was 3±8, 3±7, 4±9, and 8±13° in groups 1–4, respectively. Statistical analysis showed group 1 had no significant difference in the accuracy of “Perfect and Clinical acceptable” as well as deviation sagittal or transversal, respectively, compared with groups 2 and 3 but not group 4.ConclusionsRobotic-assistance technology no clear advantage in terms of accuracy compared to the navigation template or O-arm systems for screw implantation, but it significantly reduced adverse events, fluoroscopy time per screw, postoperative stay, and blood loss.

Robotic Spine Surgery and Augmented Reality Systems: A State of the Art

“…Fomekong et al 76 proved that the cumulative radiation exposure remained below measurable levels with the use of robotic systems. Similarly, Fan et al 77 reported that the average fluoroscopy time for screw placement in RAN was 4.02 ± 1.6 minutes vs. 8.89± 3.1 using the FH technique. Roser et al 78 found a trend toward decreased radiation time with robotic assistance, whereas Ringel et al 25 reported similar intraoperative radiation times between the robotic-assisted and the FH methods.…”

“…Moreover, the study reported postoperative infections in 2.7% of the patients undergoing robot-guided procedures compared to 10.7% in open nonrobotic ones. Fan et al 77 showed that under robotic guidance blood loss was also reduced (362± 120 mL using RAN vs. 557± 261 in FH procedures). www.e-neurospine.org 95 Kim et al 82 documented a decrease in time to ambulation after robotic surgery, with an average of 39.7 hours for FH technique versus a mean of 36.2 hours using the Renaissance system.…”

Robotic-Assisted Systems for Spinal Surgery

“…Kim and colleagues noted a significant reduction in fluoroscopy duration in later cases when compared to the early cases [41]. In a study comparing different guiding methods for pedicle screw insertion, Fan et al showed that robotic-assisted technique was associated with shorter fluoroscopic time than conventional, freehand technique or O-arm-based navigation but longer time than patient-specific navigational template technique [42]. Another study looking at different screw insertion guiding techniques showed the lowest dose of radiation in the standard navigation group, which was followed by the robotic group and then the conventional, freehand group [28].…”

Guideline for Thoracolumbar Pedicle Screw Placement Assisted by Orthopaedic Surgical Robot

“…Computer‐assisted navigation techniques started be applied in spine surgery in 1995, with the purpose of improving the accuracy of instrumentation and the safety of surgery. Studies have shown the increased accuracy and precision of pedicle screw placement, the decreased intraoperative radiation exposure, and the improved safety of minimally invasive spinal surgery under the assistance of navigation techniques. Driven by the developments in technology, combining computer‐assisted navigation and surgical robot techniques, orthopaedic surgical robots are now being to be applied in the clinic.…”